Cheyne-Stokes and Abnormal Patterns of Respiration

Authored by Dr Roger Henderson, 06 Nov 2014

Reviewed by:
Dr Adrian Bonsall, 06 Nov 2014

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Cheyne-Stokes respiration is also known as periodic respiration, with cycles of respiration that are increasingly deeper then shallower with possible periods of apnoea. Although 50% of patients with moderate-to-severe congestive heart failure are affected by significant Cheyne-Stokes respiration, its exact pathophysiology remains unclear.[1]Typically, over a period of one minute, a 10- to 20-second episode of apnoea or hypopnoea occurs followed by respirations of increasing depth and frequency. The cycle then repeats itself.

  • Patients with Cheyne-Stokes respiration usually present with the symptoms of orthopnoea, paroxysmal nocturnal dyspnoea, excessive daytime sleepiness and witnessed apnoeas in the setting of congestive heart failure.[2]
  • Cheyne-Stokes respiration is a poor prognostic sign, most often seen in terminal care. However, it may also be present as a normal finding in children, in healthy adults following fast ascending to great altitudes, or in sleep.
  • Causes include:
    • Brainstem lesions: cerebrovascular event.
    • Encephalitis.
    • Raised intracranial pressure.
    • Heart failure.[3]
    • Chronic pulmonary oedema.
    • Altitude sickness.
  • Management includes medical therapy directed at congestive heart failure, continuous positive airway pressure (CPAP) and/or supplemental oxygen.[4]
  • Acute dyspnoea causing the patient to awake from sleep and then sit upright or stand out of bed for relief.
  • Associated with pulmonary oedema due to left ventricular failure (eg, due to mitral stenosis, aortic insufficiency or hypertension) but nocturnal attacks of bronchial asthma may be difficult to differentiate.
  • Paroxysmal nocturnal dyspnoea results from increased left ventricular filling pressures due to nocturnal fluid redistribution and enhanced renal reabsorption and therefore has a greater sensitivity and predictive value than dyspnoea.

This breathing is deep sighing respiration associated with metabolic acidosis - eg, diabetic ketoacidosis, chronic kidney disease.

  • Acute dyspnoea occurring in terminal stages of exsanguinating haemorrhage.
  • It is a grave sign and indicates the need for immediate transfusion.

Hyperventilation may cause abnormally low levels of carbon dioxide in the blood and lead to dizziness, light-headedness, weakness, unsteadiness, muscle spasms in the hands and feet, and tingling around the mouth and fingertips. Causes include:

  • Anxiety.
  • Head injury.
  • Cerebrovascular event (pontine lesions); breathing is noisy.
  • Inappropriate use of stimulant drugs; excessive intake of aspirin.
  • Hypoventilation is breathing that is not adequate to meet the needs of the body (too shallow or too slow).
  • Hypoventilation causes an increase in blood carbon dioxide level and a decrease in oxygen level.
  • Causes include:
    • Central nervous system - eg, drugs (central nervous system depressants), cerebrovascular events, trauma, neoplasms.
    • Obesity.
    • Obstructive sleep apnoea.
    • Severe chest wall deformities - eg, kyphoscoliosis.
    • Neuromuscular diseases - eg, myasthenia gravis, amyotrophic lateral sclerosis, Guillain-Barré syndrome, muscular dystrophy.
    • Severe chronic obstructive pulmonary disease.
    • Congenital Central Hypoventilation Syndrome is a rare cause of hypoventilation in children and is present from birth.[5]
  • Obstructive sleep apnoea is caused by intermittent and repeated upper airway collapse during sleep.
  • This results in irregular breathing at night, and excessive sleepiness during the day.

Further reading and references

  1. Ingbir M, Freimark D, Motro M, et al; The incidence, pathophysiology, treatment and prognosis of Cheyne-Stokes breathing disorder in patients with congestive heart failure. Herz. 2002 Mar27(2):107-12.

  2. Cherniack NS, Longobardo G, Evangelista CJ; Causes of Cheyne-Stokes respiration. Neurocrit Care. 20053(3):271-9.

  3. AlDabal L, BaHammam AS; Cheyne-stokes respiration in patients with heart failure. Lung. 2010 Jan-Feb188(1):5-14. doi: 10.1007/s00408-009-9200-4. Epub 2009 Dec 3.

  4. Momomura S; Treatment of Cheyne-Stokes respiration-central sleep apnea in patients with heart failure. J Cardiol. 2012 Mar59(2):110-6. doi: 10.1016/j.jjcc.2011.12.008.

  5. Chen ML, Keens TG; Congenital central hypoventilation syndrome: not just another rare disorder. Paediatr Respir Rev. 2004 Sep5(3):182-9.

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